Patient Intake
Start Your Child's Intake Online
This is the same intake our office walks families through, in an online form you can finish from your phone. Everything you share is confidential and goes straight to our clinical team.
Before you begin
A little preparation keeps this quick.
About 15 minutes
Short answers are fine. We follow up on details together.
Insurance card
Have the plan name and member ID nearby.
Doctor and diagnosis info
Physician name, diagnosis, and medications if you have them.
Questions while you fill this in?
For Insurance Authorization
Documents We Will Need
These come after the form, not before. Missing some? That is normal. We help you chase them down. Send them by email, by fax, or bring them to your first visit.
- 1. Referral or Prescription for ABA TherapyFrom a licensed physician, with the ICD-10 code(s) based on the diagnosis.
- 2. Medical Necessity LetterName, date of birth, diagnosis confirmation, and rationale for ABA as medically necessary.
- 3. Comprehensive Diagnostic EvaluationA diagnostic report from a licensed physician, psychologist, or neurologist.
- 4. Insurance CardsFront and back of all active cards, primary and secondary.
- 5. IEP or 504 Plan, If ApplicableThe most recent copy from your child's school.
- 6. Previous ABA Records, If ApplicablePrior assessments, behavior plans, and a transfer form when switching providers.
After We Have Everything
What Happens Next
Insurance authorization can take up to 90 days after all documents are in. Contact us if you need accommodations sooner; we are here for your child through the whole process.
We Submit Your Documents
Your completed intake and required documents go to your insurance provider.
Insurance Makes A Decision
Your plan lets us know whether the initial assessment is approved.
We Schedule The Initial Assessment
If approved, we arrange an assessment with one of our providers.
We Submit The Assessment
We send the provider's report to your insurance for review.
Insurance Confirms Approval And Hours
Your plan confirms whether services are approved and how many weekly hours it will cover.
Meet Your Team And Begin Services
We arrange a meet and greet and set up your first sessions.